Muscle compensation strategies to maintain glenohumeral joint stability with increased rotator cuff tear severity: A simulation study

Rotator cuff tear (RCT) in older adults may cause decreased muscle forces and disrupt the force balance at the glenohumeral joint, compromising joint stability. Our objective was to identify how increased RCT severity affects glenohumeral joint loading and muscle activation patterns using a computational model. Muscle volume measurements were used to scale a nominal upper limb model's peak isometric muscle forces to represent force-generating characteristics of an average older adult male. Increased RCT severity was represented by systematically decreasing peak isometric muscle forces of supraspinatus, infraspinatus, and subscapularis. Five static postures in both scapular and frontal planes were evaluated. Results revealed that in both scapular and frontal planes, the peak glenohumeral joint contact force magnitude remained relatively consistent across increased RCT severity (average 1.5% and −4.2% change, respectively), and a relative balance of the transverse force couple is maintained even in massive RCT models. Predicted muscle activations of intact muscles, like teres minor, increased (average 5–30% and 4–17% in scapular and frontal planes, respectively) with greater RCT severity. This suggests that the system is prioritizing glenohumeral joint stability, even with severe RCT, and that unaffected muscles play a compensatory role to help stabilize the joint.